Over the past five years, we have developed new type of liver magnetic resonance imaging (MRI) scans that can be used to measure scarring and deposition of fat and iron. We have shown that they could potentially replace liver biopsies, a procedure that involves taking a small sample of body tissue so it can be examined under a microscope, and help clinicians predict which patients are more likely to suffer complications from their liver disease.
This work has established a collaboration between MR clinicians and basic scientists in the University of Oxford, clinical gastroenterologists and hepatologists in the NHS and Perspectum Diagnostics, a University of Oxford spin out company.
In this sub-theme, we aim to investigate how technologies developed through this collaboration can be used to address clinically relevant questions in hepatico-pancreato-biliary medicine.
Diagnosis of Biliary Strictures
Differentiation between benign and malignant bile duct strictures with current standard methods remains a challenge with up to 20% remaining indeterminate through pre-operative evaluation, potentially necessitating a major surgical intervention for a definitive diagnosis.
Conventional MRI methods of examining the biliary tree have improved non-invasive diagnosis over the past few decades. However, these techniques remain disadvantaged by the subjective interpretation of radiologists and the associated observer dependent variability. Histology or cytology to confirm the underlying diagnosis is often needed, but this requires an invasive procedure, which has sub-optimal accuracy and significant risk of complications.
Primary Sclerosing Cholangitis
Primary Sclerosing Cholangitis (PSC) is a progressive disease of the bile ducts that can lead to liver cirrhosis and cancer. PSC is characterised by inflammation and scarring of the bile ducts and gives characteristic appearances on imaging. Over time, liver scarring develops as a consequence of the biliary disease. Current approaches to the assessment of PSC require separate scans for the assessment of the biliary and liver component of the condition. Here we will assess how our technology could assess both components in a single quantitative scan.
Overall, we aim to develop new quantitative imaging methods of the liver and biliary tree to substantially improve biliary tree 3D visualization, including image fusion with liver tissue characterisation sequences to detect, for example, any association of biliary strictures with regional inflammation. Better non-invasive diagnosis could radically change the management pathways of patients with biliary diseases. We will therefore evaluate how quantitative imaging of the bile ducts and the surrounding liver could be used to improve non-invasive diagnosis.
Adam Bailey and Michael Pavlides
Translational Gastroenterology Unit
Oxford University Hospitals NHS Foundation Trust